Problems in patient care linked to deaths

A QUARTER of all surgical patient deaths involve potential problems with care that could or should have been provided differently, a massive national audit has found.

And one in every 20 deaths led to significant criticism of the care given to the patient, according to the Australian and New Zealand Audit of Surgical Mortality.

In about 1 per cent of cases, the clinical problems were found to have probably caused the person's death.

The audit's chairman, Guy Maddern, said the potential problems were those where it might have been possible to tackle the issue differently and bring about different results.

''It may have been that a scan should have been done earlier or an antibiotic prescribed, it may not have made any difference but with the benefit of hindsight we have identified it,'' he said.

The audit, which is run by the Royal Australasian College of Surgeons and examined more than 10,000 deaths over three years, found the most common areas of concern were problems with delays in treatment, or the decision to operate at all.

Professor Maddern said he believed the audit, in its third year, could prevent patient deaths. In Western Australia, where an audit has been run for about 10 years, deaths seemed to be decreasing.

''We think what might be happening is we might be finding surgeons who are realising it might not always be necessary to do [surgery],'' he said. ''Often these patients are put in front of a surgeon and they feel obliged to do something, and this audit is giving them the confidence to say 'this surgery is not going to provide a meaningful solution.' ''

In most of the audit areas the national figures showed improvements on previous years, and the vast majority of deaths involved no significant criticisms.

The proportion of surgeons participating has also increased drastically, from 60 per cent last year to 90 per cent this year.

But Professor Maddern criticised private hospitals in NSW and Queensland that had been slow to participate, despite the NSW government now funding the process here.

Other problems identified in the audit included patients not being moved into a critical care unit, with 12 per cent who had not received critical care treatment likely to have benefited from it. Patients had also missed out on preventative treatment for deep vein blood-clots, and experienced delays in transport to other hospitals.

''Most of these deaths are occurring in the older age groups, and they have many co-morbidities … the surgery is in many ways the easy part; it's managing these other conditions in the post-surgical period that is extremely complex," Professor Maddern said.

The chief executive of the NSW Clinical Excellence Commission, Cliff Hughes, said every surgeon would receive a personal audit report, which was conducted in a similar manner to a jury trial, and a summary at the end of the year.

He said such detailed feedback was ''pretty much a world-first'', and had been driven by surgeons and anaesthetists in NSW.

He could not say how many private hospitals in NSW were currently participating in the audit process, but was confident the number would improve.

The Australian Private Hospitals Association did not respond to a request for comment.